Common use of How to Use This Health Plan Clause in Contracts

How to Use This Health Plan. PLEASE READ THE FOLLOWING INFORMATION SO YOU WILL KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED. Selecting a Primary Care Physician Each Member must select a general practitioner, family practitioner, internist, obstetrician/gynecol- ogist, or pediatrician as their Primary Care Physi- cian at the time of enrollment. Individual Family members must also designate a Primary Care Physician, but each may select a different provider as their Primary Care Physician. A list of Blue Shield Access+ HMO Providers is available online at xxx.xxxxxxxxxxxx.xxx. Members may also call the Customer Service Department at the number provided on the back page of this EOC for assis- tance in selecting a Primary Care Physician. The Member’s Primary Care Physician must be lo- cated sufficiently close to the Member’s home or work address to ensure reasonable access to care, as determined by Blue Shield. If the Member does not select a Primary Care Physician at the time of enrollment, Blue Shield will designate a Primary Care Physician and the Member will be notified. This designation will remain in effect until the Member requests a change. A Primary Care Physician must also be selected for a newborn or child placed for adoption within 31 days from the date of birth or placement for adoption. The selection may be made prior to the birth or placement for adoption and a pediatrician may be selected as the Primary Care Physician. For the month of birth, the Primary Care Physician must be in the same Medical Group or Independent Practice Association (IPA) as the mother’s Pri- xxxx Care Physician when the newborn is the nat- ural child of the mother. If the mother of the new- born is not enrolled as a Member or if the child has been placed with the Subscriber for adoption, the Primary Care Physician selected must be a Physi- cian in the same Medical Group or IPA as the Sub- xxxxxxx. If a Primary Care Physician is not selected for the child, Blue Shield will designate a Primary Care Physician from the same Medical Group or IPA as the natural mother or the Subscriber. This designation will remain in effect for the first cal- endar month during which the birth or placement for adoption occurred. To change the Primary Care Physician for the child after the first month, see the section below on Changing Primary Care Physicians or Designated Medical Group or IPA. The child must be enrolled with Blue Shield to continue coverage beyond the first 31 days from the date of birth or placement for adoption. See the Eligibility and Enrollment section for additional information. Primary Care Physician Relationship The Physician-patient relationship is an important element of an HMO Plan. The Member’s Primary Care Physician will make every effort to ensure that all Medically Necessary and appropriate pro- fessional services are provided in a manner com- patible with the Member’s wishes. If the Member and Primary Care Physician fail to establish a sat- isfactory relationship or disagree on a recom- mended course of treatment, the Member may con- tact Customer Service at the number provided on the back page of this EOC for assistance in select- ing a new Primary Care Physician. If a Member is not able to establish a satisfactory relationship with his or her Primary Care Physician, Blue Shield will provide access to other available Primary Care Physicians. Role of the Primary Care Physician The Primary Care Physician chosen by the Mem- practice Physician who is not her designated Pri- xxxx Care Physician without a referral from the Primary Care Physician or Medical Group/IPA. However, the obstetrician/gynecologist or family practice Physician must be in the same Medical Group/IPA as the Member’s Primary Care Physi- cian. Obstetrical and gynecological services are defined as Physician services related to:

How to Use This Health Plan. PLEASE READ THE FOLLOWING INFORMATION SO YOU WILL KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED. Selecting a Primary Care Physician Each Member must select a general practitioner, family practitioner, internist, obstetrician/gynecol- ogist, or pediatrician as their Primary Care Physi- cian at the time of enrollment. Individual Family members must also designate a Primary Care Physician, but each may select a different provider as their Primary Care Physician. A list of Blue Shield Access+ Trio HMO Providers is available online at xxx.xxxxxxxxxxxx.xxx. Members may also call the Customer Service Department Shield Concierge at the telephone number provided pro- vided on the back page of this EOC for assis- tance assistance in selecting a Primary Care Physician. Physician The Member’s Primary Care Physician must be lo- cated sufficiently close to the Member’s home or work address to ensure reasonable access to care, as determined by Blue Shield. If the Member does not select a Primary Care Physician at the time of enrollment, Blue Shield will designate a Primary Care Physician and the Member will be notified. This designation will remain in effect until the Member requests a change. A Primary Care Physician must also be selected for a newborn or child placed for adoption within 31 days from the date of birth or placement for adoption. The selection may be made prior to the birth or placement for adoption and a pediatrician may be selected as the Primary Care Physician. For the month of birth, the Primary Care Physician must be in the same Medical Group or Independent Practice Association (IPA) as the mother’s Pri- xxxx Care Physician when the newborn is the nat- ural child of the mother. If the mother of the new- born is not enrolled as a Member or if the child has been placed with the Subscriber for adoption, the Primary Care Physician selected must be a Physi- cian in the same Medical Group or IPA as the Sub- xxxxxxx. If a Primary Care Physician is not selected for the child, Blue Shield will designate a Primary Care Physician from the same Medical Group or IPA as the natural mother or the Subscriber. This designation will remain in effect for the first cal- endar month during which the birth or placement for adoption occurred. To change the Primary Care Physician for the child after the first month, see the section below on Changing Primary Care Physicians or Designated Medical Group or IPA. The child must be enrolled with Blue Shield to continue coverage beyond the first 31 days from the date of birth or placement for adoption. See the Eligibility and Enrollment section for additional information. Primary Care Physician Relationship The Physician-patient relationship is an important element of an HMO Plan. The Member’s Primary Care Physician will make every effort to ensure that all Medically Necessary and appropriate pro- fessional services are provided in a manner com- patible with the Member’s wishes. If the Member and Primary Care Physician fail to establish a sat- isfactory relationship or disagree on a recom- mended course of treatment, the Member may con- tact Customer Service at the number provided on the back page of this EOC for assistance in select- ing a new Primary Care Physician. If a Member is not able to establish a satisfactory relationship with his or her Primary Care Physician, Blue Shield will provide access to other available Primary Care Physicians. Role of the Primary Care Physician The Primary Care Physician chosen by the Mem- practice Physician who is not her designated Pri- xxxx Care Physician without a referral from the Primary Care Physician or Medical Group/IPA. However, the obstetrician/gynecologist or family practice Physician must be in the same Medical Group/IPA as the Member’s Primary Care Physi- cian. Obstetrical and gynecological services are defined as Physician services related to:on